Patient Billing Rep II

Best Care; Omaha (NE); On-site; USD 42,000 - 62,000; Full time

Job summary

Nebraska Methodist Health System is seeking a Billing Specialist to manage patient accounts, electronic claim submissions, and follow-up to maximize reimbursement. The role emphasizes accuracy, payer compliance, and collaborative communication within a corporate billing team.

The position requires handling UB04/837I and CMS1500/837P claims, auditing accounts, and documenting actions in the Source System, with a daytime office schedule in Omaha, NE.

Qualifications

• Experience with patient billing and accounts receivable processes.
• Ability to interpret and follow payer guidelines.

Responsibilities

• UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation.
• Submits claims in accordance with department and payer guidelines.
• Prepares secondary and tertiary billings for accurate reimbursement.
• Audits accounts and documents findings in the Source System.

Skills

Billing

Claims submission

Job description

Why work for Nebraska Methodist Health System?

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Location: Methodist Corporate Office
Address: 825 S 169th St. - Omaha, NE

Work Schedule: Mon - Fri; daytime business office hours

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Responsibilities:

Essential Functions

UB04/837I and CMS1500/837P Claim Edit Handling/Billing/Interpretation

• All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
• Obtains appropriate EOB’s through use of health system resources.
• Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
• Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
• Prepares secondary and tertiary billings, manually and electronically on UB04’s and/or 1500’s for accurate reimbursement.
• Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.

Display Effective Communication Skills

• Demonstrates active listening skills.
• Notifies and keepssupervisor informed on denial and any other trendsidentified.
• Follows telephone etiquette procedures set forth by the organization and/or individual department.
• Professional/Courteous responses when communicating with customers, health system staff and management.
• Can effectively communicate in meetings/forums to a large or medium group of individuals.
• Works with supervisor to streamline process and decrease inefficiencies.

Handling of Referrals

• Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
• Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
• If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question.

Knowledge of System Applications

• Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
• Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.
• Assists with testing and roll out plans to introduce new functionality within system applications used by the department.

Auditing of Patient Accounts

• Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
• Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
• Leverages all needed resources to complete an audit of an account.
• Documents audit finding and actions taken in Source System when necessary.

Claim/Appeal Follow Up with Third Party Payers

• Full understanding of all necessary third party payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements.
• Leverages payer websites, automated tools and contract resources to streamline the follow up process.